Patients and families facing serious illness often want and need their clinicians to help guide medical decision making by offering a recommendation. Yet clinicians worry that recommendations are not compatible with shared decision making and feel reluctant to offer them. We describe an expert approach to formulating a recommendation using a shared decision-making framework. We offer three steps to formulating a recommendation: 1) evaluate the prognosis and treatment options; 2) understand the range of priorities that are important to your patient given the prognosis; and 3) base your recommendation on the patient's priorities most compatible with the likely prognosis and available treatment options.
The initiatives implemented by the transfusion coordinator and endorsed by the HTCs have improved the standard of transfusion documentation and practice at both institutions.
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